Time to Disability Milestones and Annualized Relapse Rates in NMOSD and MOGAD

Area of Science:

• Neuroimmunology
• Clinical Neurology
• Autoimmune Diseases

Background:

• Neuromyelitis optica spectrum disorder (NMOSD) and MOG-antibody-associated disease (MOGAD) are inflammatory demyelinating diseases with distinct pathologies.
• Understanding disability accumulation is crucial for managing these conditions, especially with evolving treatment landscapes.

Purpose of the Study:

• To investigate the accumulation of disability in NMOSD and MOGAD.
• To identify risk factors for disability milestones, considering disease duration, attack frequency, and age.
• To analyze these factors within the context of changing treatment strategies.

Main Methods:

• Analysis of data from the German Neuromyelitis Optica Study Group registry.
• Inclusion of patients with AQP4-IgG+ NMOSD, AQP4-IgG-/MOG-IgG- NMOSD, and MOGAD.
• Application of survival analyses to estimate risk factors and time to disability milestones (EDSS).

Main Results:

• Despite similar annualized attack rates, NMOSD patients (AQP4-IgG+ and AQP4-IgG-/MOG-IgG-) reached disability milestones (EDSS 3, 4, 6, 7) significantly earlier than MOGAD patients.
• Higher age at onset was associated with increased risk for all disability milestones.
• The risk of disability accumulation appeared to decrease over time, potentially reflecting improved treatments.

Conclusions:

• Distinct patterns of relapse-associated disability progression exist between AQP4-IgG+ NMOSD, AQP4-IgG-/MOG-IgG- NMOSD, and MOGAD, with MOGAD demonstrating a less severe course.
• Investigator-initiated research and improved treatment strategies seem to be ameliorating disease outcomes in both NMOSD and MOGAD.
• Age at onset is a significant predictor of disability progression in these conditions.